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Second-line treatment of primary biliary cholangitis: To whom, which molecule, and when
Sylvia Drazilova, Peter Jarcuska, Tomas Koky, Martin Harhovsky, Slavomira Komarova, Jan Vasil, Martin Janicko, 2nd Department of Internal Medicine, PJ Safarik University, Faculty of Medicine and L Pasteur University Hospital, Kosice 04011, Slovakia
Author contributions: Drazilova S, and Jarcuska P participated in the design of the manuscript; Drazilova S, Jarcuska P, Koky T, Harhovsky M, Komarova S and Vasil J participated in data collection of the manuscript and writing-original draft; Drazilova S, Jarcuska P, and Janicko M participated in writing-review and editing. All authors have read and approved the final manuscript.
AI contribution statement: No artificial intelligence tools were used in the preparation of this manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Peter Jarcuska, MD, PhD, Professor, 2nd Department of Internal Medicine, PJ Safarik University, Faculty of Medicine and L Pasteur University Hospital, Trieda SNP 1, Kosice 04011, Slovakia. peter.jarcuska@upjs.sk
Received: March 26, 2026
Revised: June 23, 2026
Accepted: July 9, 2026
Published online: August 27, 2026
Processing time: 145 Days and 19.9 Hours
Revised: June 23, 2026
Accepted: July 9, 2026
Published online: August 27, 2026
Processing time: 145 Days and 19.9 Hours
Core Tip
Core Tip: Primary biliary cholangitis (PBC) is a disease with increasing prevalence, particularly in developed countries. First-line treatment of choice is ursodeoxycholic acid (UDCA), but only about two-thirds of patients achieve biochemical response. UDCA nonresponders have a higher risk of liver cirrhosis decompensation and poorer transplant-free survival. These patients should be considered for second-line therapy. This review provides a comprehensive overview of second-line treatment indications, selection of the most appropriate medication, timing of therapy initiation, benefits, and adverse effects of therapy, as well as the administration of second-line treatment in specific groups of PBC patients.